Healthcare Provider Details

I. General information

NPI: 1457276354
Provider Name (Legal Business Name): LYLA ROSE POLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 EARHART BLVD
NEW ORLEANS LA
70125-1955
US

IV. Provider business mailing address

605 S HENNESSEY ST
NEW ORLEANS LA
70119-6736
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-7120
  • Fax:
Mailing address:
  • Phone: 310-339-9912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: